Whooping cough (pertussis) is an acute infectious condition of the respiratory tract. The bacteria Bordetella pertussis causes it. Infection occurs mainly through droplets, which means that the bacteria are spread through the air when a sick person coughs, talks, or sneezes.
Once the pathogen is in the body, it begins to multiply and secrete pertussis toxin, which affects the functioning of the central nervous system, causes the secretion of thick and sticky mucus in the respiratory tract, and stimulates the cough center in the brain, which manifests itself in paroxysmal, choking, often leading to vomiting, long-lasting cough, which is a characteristic symptom of whooping cough.
Whooping cough is a condition caused by Bordetella pertussis, classified as a gram-negative rod. The virulence (pathogenicity) of B. pertussis is due to factors that facilitate its invasion of host cells and cause characteristic symptoms of the disease. These are substances such as:
Whooping cough is a highly contagious disease caused by the pertussis bacterium. It spreads through the air via droplet transmission when an infected individual coughs or sneezes, releasing mucus particles that other people may inhale. Contact with surfaces contaminated by nasal discharge or saliva is not a significant risk, as these bacteria do not survive well outside the body.
Newborns are particularly sensitive to this infection due to their underdeveloped immune systems. They do not receive protective antibodies against pertussis from their mothers through the placenta (passive immunity). Usually, young children are infected by older siblings, parents, or caregivers who may not even realize they are ill, as adults often show mild or even no symptoms.
If a child has a severe cough or a cough that lasts longer than two weeks, it is significant to seek medical advice. In cases of apnea (pauses in breathing) in infants or children, it is crucial to call for an ambulance immediately.
The sources of illness are sick people – both kids with full-blown condition, as well as adolescents and adults, in whom the disease can be mild and non-specific or with few signs. The grandest contagiousness appears in the first two weeks of the infection and lasts up to 4 weeks, with proper antibiotic treatment shortening contagiousness to 5 days. Significantly, there is no carrier of pertussis bacilli, so you cannot get infected from completely healthy individuals.
Whooping cough is very contagious, even more so than chickenpox. The risk of a susceptible person getting sick after contact with an ill person exceeds 80%. The disease is transmitted through droplets during coughing and sneezing, as well as through direct contact, although in this situation, the contagiousness is much lower. People with whooping cough should isolate themselves for 5 days after starting effective antibiotic therapy, and if antibiotics have not been used, isolation for 3 weeks after the onset of paroxysmal coughing is recommended.
The course of a whooping cough infection may vary depending on the patient's immunization status. People who have had whooping cough in the past or have been vaccinated against it usually have a much milder course. Often the clinical picture is then atypical. It is dominated by a non-specific cough. The symptoms are mild but usually persist for a long time. If whooping cough is suspected, contact a doctor immediately.
The main symptoms in children include:
After a dozen or so days, whooping cough changes to a phase of paroxysmal coughing, during which the following occurs:
The disease progresses differently in adults than in children. First of all, it is less dynamic and lasts quite a long time – even up to 26 weeks.
The ailments that adults with whooping cough complain about are:
The incubation period of the disease is on average seven days, symptoms usually last 6 weeks, sometimes longer. Symptoms of the condition differ depending on the phase of the illness. In the course of whooping cough, we distinguish 3 phases.
Catarrhal phase – lasting 1-2 weeks, characterized by flu-like symptoms, i.e.:
In this phase, the whooping cough bacteria penetrate and multiply in the mucous membranes and invade the lymphatic vessels. During the invasion of host cells, the bacteria secrete several toxins that damage tissues, leading to inflammation in the respiratory tract.
The next phase is the paroxysmal cough stage, where the symptoms become more severe. The cough becomes increasingly tiring and produces more mucus. This stage typically lasts 2 to 4 weeks and results from the heightened secretion of bacterial toxins, which damage the epithelium of the respiratory tract and trigger coughing.
The cough is described as paroxysmal – the child coughs repeatedly, without a break between coughs, and cannot catch their breath. Only after some time does the child take a breath, during which the air flows rapidly through the narrowed larynx, making a whistling sound resembling foaming. During the cough, thick mucus secretion may be expected, and additional symptoms may appear, such as:
A coughing attack usually ends with vomiting, but apnea may also occur. In some children, the strain associated with coughing leads to hernia development. Characteristically, no other symptoms of the disease are observed between coughing attacks, and there is no fever. Coughing attacks may be more or less frequent, but due to their great intensity, children are usually afraid of another attack, become apathetic and lose their appetite.
In small children – newborns and infants up to 3 months of age, the disease may not have the typical symptoms described above. These children have not yet developed a proper cough reflex, and apnea and cyanosis are the only symptoms of the disease. It is believed that whooping cot is one of the causes of the so-called cot death in infants.
The convalescence phase is characterized by the gradual passing of coughing attacks and the patient's recovery. Vomiting and cyanosis stop, well-being improves, and appetite returns.
The clinical course of whooping cots in previously vaccinated people is milder and less typical. It manifests itself mainly with a persistent, hard-to-control dry cough, but there is no so-called foaming, vomiting, or apnea. Once the disease has been through, it provides long-term immunity, but recurrence is possible.
The doctor will first collect an interview and then examine the patient. On this basis, the doctor may suspect whooping cough, especially in the case of a cough that lasts more than 3 weeks and is not explained by another cause. The diagnosis is made on the basis of serological tests, i.e. blood or microbiological tests.
At the beginning of the disease, within 3 weeks of the appearance of the cough, a throat swab can be taken for microbiological tests. After this time, a blood test for IgG antibodies against pertussis toxin is performed. However, this test is not reliable in people vaccinated against pertussis within the last year.
If the course of the disease is typical and the patient has had contact with a person with pertussis, the diagnosis is certain and does not require additional tests.
We use antibiotics to treat pertussis. Treatment should be started within 3 weeks of the appearance of a cough. In the acute catarrhal phase of whooping cough, treatment with a proper antibiotic can prevent the development of the condition. In the developed phase of cough, antibiotics only shorten the period of contagion but have no effect on the manifestation and course of the condition. The antibiotics used to treat pertussis include cotrimoxazole. The patient takes one antibiotic for 5 to 14 days, depending on the type of antibiotic. As with any antibiotic therapy, do not end or interrupt the treatment.
A person with whooping cough stops being contagious after 5 days of proper antibiotic therapy. Unfortunately, there are no drugs with proven effects that alleviate whooping cough in the advanced phase of the disease.
In severe cases, treatment must take place in a hospital, because sometimes oxygen therapy and even mechanical ventilation are also necessary.
There are some practices that you can do to prevent getting ill. The basic method of preventing pertussis is vaccination.
As part of the mandatory vaccination schedule for children in many countries, protection against severe pertussis is provided by a conjugated vaccine against diphtheria, tetanus and pertussis (DTP).
The immunization schedule includes Administering vaccine doses to children at 2, 3 or 4, 5 or 6, and 16, or at 18 months of age, and then at 6 years of age. At 14 years of age, a teenager should receive a booster dose that contains reduced pertussis antigen content. To maintain immunity, the vaccination should also be repeated at 19 years of age.
In the case of adults, it is worth remembering to administer a booster dose every 10 years. Importantly, neither vaccination nor having had pertussis provides lasting immunity. However, re-infection is usually much milder than the original infection. It should be remembered that any post-vaccination effects are mild and much lower than the risk associated with having had pertussis and its complications.
Whooping cough can be especially harmful to infants and women in the third trimester of pregnancy. For this reason, if they have close contact with an ill individual, they should take a dose of antibiotics as part of post-exposure prevention. Due to the high risk of complications in these groups, it is essential to take protective measures regardless of their immunization status.
Individuals with whooping cough must stay at home to stop bacteria from spreading. Isolation can end no sooner than 5 days after beginning antibiotic therapy. If no medicine is given, isolation should be extended to 3 weeks from the start of coughing attacks. In each situation, the doctor determines the patient's action.
Recommended vaccinations against pertussis include:
Contraindications to vaccination include:
A detailed history of adverse reactions to childhood vaccinations is highly emphasized. Stable neurological conditions are not a contraindication for receiving the DTaP vaccine. Studies by the CDC highlight the significant risk of severe complications from pertussis in young adults with chronic neurological diseases. Conditions such as immune disorders, including HIV infection, or the use of immunosuppressive therapy do not prevent vaccination; however, the effectiveness of the protective immune response may be reduced. The Tdap vaccine can be administered in combination with other vaccines, whether they are attenuated or inactivated.
The most commonly observed adverse reactions following vaccination are local reactions at the injection site and occur within 48 hours of vaccination. These include redness, pain, swelling, itching, and fever. Other complications include headache, fatigue, general malaise, muscle pain, and hives. Severe anaphylactic reactions have been reported very rarely.
According to data from the World Health Organization (WHO), whooping cough is particularly dangerous for infants under 6 months of age, and in countries with a high level of vaccination, the number of whooping cough cases in this age group is much lower, which is directly related to the vaccination program for pregnant women.
Vaccination against whooping cough during pregnancy is highly recommended because it offers significant protection to the newborn during the early months of life before the baby can receive vaccinations. The ideal time for a mother to get vaccinated is between the 27th and 36th week of pregnancy, allowing antibodies to be transferred to the baby through the placenta.
Newborns are especially vulnerable to whooping cough, and their immune systems are not yet developed enough to combat the infection. By vaccinating the mother while she is pregnant, she can pass on antibodies to her baby, providing essential protection during those first few months of life until the baby can receive its first doses.
The effectiveness of the Tdap combination vaccine after a full cycle of basic doses in children is over 80-90%, which significantly reduces the risk of infection. However, immunity decreases after a few years, so booster doses are crucial, especially for adults and people exposed to contact with young children.
Children vaccinated against whooping cough may occasionally get sick, but this is rare. In cases where infection occurs after vaccination, the symptoms of the disease are less severe and are often limited to a prolonged cough, without more serious complications such as pneumonia or respiratory damage, which is more typical for unvaccinated children.
Studies indicate that vaccinated people who nevertheless become ill also help to limit the spread of the disease because their course of infection is shorter and the amount of bacteria excreted is lower than in the case of unvaccinated people. It makes the vaccine very important for protecting the individual and the entire population, especially newborns who cannot yet take vaccines on their own.
Post-exposure prophylaxis of pertussis involves the use of antibiotics in non-immune individuals from close contact with a person with pertussis within 21 days of exposure. Antibiotics are used according to the same scheme as in the treatment of pertussis. It is particularly recommended to implement this form of prophylaxis in individuals at high risk of complications of pertussis and in individuals who have close contact with individuals from such a group. These groups include:
Washing hands and practicing good respiratory hygiene, such as covering your mouth and nose when coughing or sneezing, can help reduce the spread of Bordetella pertussis, the bacteria that causes whooping cough.
Individuals who are at higher risk, such as infants and pregnant women, may be given antibiotics to prevent the disease if they are exposed to it.
Those who have been confirmed to have whooping cough should stay home and avoid close contact with others, especially infants and individuals with weakened immune systems until they have completed a course of antibiotics.
Educating the public about whooping cough, including its symptoms, risks, and prevention methods, can promote vaccinations and other preventive practices.
Effective surveillance and reporting of whooping cough cases are essential for quickly detecting outbreaks and preventing further spread of the disease.
In the case of older children and adults, whooping cough usually completely recovers after a bout of whooping cough, and the disease disappears without leaving permanent complications. In newborns and infants, however, whooping cough can be very severe and threat health and life. There is also a high risk of complications in people who are additionally treated for chronic diseases.
A bout of whooping cough can lead to the development of:
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